July 1, 2020 – June 30, 2025

July 1, 2020 ? June 30, 2025

Effective 7-1-2020 Revised 7-29-2021

CASE MANAGEMENT AND CLINICAL SERVICES MANUAL

Table Of Contents

Part I: General Information ................................................................................... I.1 1.00 ? Purpose and Use of the Manual...................................................................I.1

Part II: SCA Needs Assessment and Plan..............................................................II.1 2.00 ?SCA Needs Assessment and Plan............................................................... II.1

Part III: Special Populations ............................................................................... III.1 3.00 ? Priority Populations................................................................................. III.1 3.01 - Pregnant Women...................................................................................... III.1 3.02 - Persons Who Inject Drugs (PWID) ........................................................... III.2 3.03 - Women with Children .............................................................................. III.4 3.04 - Overdose Survivors.................................................................................. III.4 3.05 - Veterans................................................................................................... III.6

Part IV: Service Continuum .................................................................................IV.1 4.00 - Continuum of Care...................................................................................IV.1 4.01 - Halfway House Services...........................................................................IV.1 4.02 - Emergency Housing Services....................................................................IV.3 4.03 - Recovery Housing....................................................................................IV.4 4.04 - Medication Assisted Treatment (MAT).....................................................IV.4

Part V: Case Management..................................................................................... V.1 5.00 - Case Management Overview ..................................................................... V.1 5.01 - Screening.................................................................................................. V.2 5.02 - Assessment and Placement Determination.................................................. V.3 5.03 - Referral and Admission to Treatment......................................................... V.5 5.04 - Communicable Disease Screening and Referral Services ............................ V.6 5.05 - Coordination of Services ........................................................................... V.8 5.06 - WITS Case Management Requirements ..................................................... V.9 5.07 - Supervision............................................................................................. V.10 5.08 - Staffing Qualifications............................................................................. V.10 5.09 - Core Training.......................................................................................... V.11 5.10 - Grievance and Appeal Process................................................................. V.13 5.11 - Reporting................................................................................................ V.15 5.12 - Confidentiality of Information ................................................................. V.15

Part VI: Recovery Support Services.....................................................................VI.1 6.00 -Recovery Support Services........................................................................VI.1

Part VII: Culturally and Linguistically Appropriate Services .......................... VII.1 7.00 ? Culturally and Linguistically Appropriate Services (CLAS) .....................VII.1

Part VIII: Miscellaneous....................................................................................VIII.1 8.00 - Miscellaneous ....................................................................................... VIII.1

Part IX: Contingency Management......................................................................IX.1 9.00 - Contingency Management ........................................................................IX.1

Appendix A: Acronyms.......................................................................................... A.1

Appendix B: Glossary ............................................................................................ B.1

Part I - General Information

PART I: GENERAL INFORMATION

1.00 Purpose and Use of the Manual

The mission of the Department of Drug and Alcohol Programs (DDAP) is to engage, coordinate and lead the Commonwealth of Pennsylvania's effort to prevent and reduce substance use disorders (SUD) and to promote recovery, thereby reducing the human and economic impact of the disease. This work is carried out in conjunction with the Single County Authorities (SCAs), their contracted providers, and the community at large. The SCAs have flexibility to develop their service delivery system in response to community needs.

DDAP has developed the Case Management and Clinical Services Manual (CMCSM) to comply with and convey the requirements of the Substance Abuse Block Grant (SABG) and 4 Pa. Code? 257.4. The CMCSM sets forth requirements for SCAs and their contracted providers in delivering services to individuals with SUD and their families.

The SCA Grant Agreement takes precedence over the Prevention, Case Management/Clinical Services, Fiscal and Operations Manuals issued by DDAP, unless otherwise specified by DDAP or the Commonwealth, such as in Policy Bulletins or Management Directives. In addition, it may be necessary to issue temporary instructions, which will take precedence over material in this Manual. Any temporary instructions will clearly state the exception and include an expiration date.

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Part II - SCA Needs Assessment and Plan

PART II: SCA NEEDS ASSESSMENT AND PLAN

2.00 SCA Needs Assessment and Plan

To adequately plan for services most needed, SCAs must complete a Needs Assessment in order to identify any demographic changes that must be considered, current service use, including capacity and access issues, and any other areas of concern, gaps or needs that should be addressed. The SCA Needs Assessment and subsequent Plan provide the opportunity for SCAs to present information to DDAP on how the SCA is providing services related to SUD in the most efficient and effective manner and at the most appropriate level of care to individuals in need of services. The information provided by the SCAs will significantly contribute to DDAP's ability to detect patterns of unmet need and provide a strategic insight to improve the service delivery system.

SCAs are different in their geography, economics, population demographics, and density. Substance use trends and vulnerable populations change over time and across communities. These changes impact prevalence, incidence, and treatment demand estimates, which SCAs can use to match available resources with projected demand and plan for the development of new resources based upon needs. The Needs Assessment is a process through which the SCA uses reliable data to estimate the prevalence of SUD for people in its area. The Needs Assessment further identifies emerging SUD trends that may impact demand for treatment and services, methods to address SUD, and potential barriers to providing effective treatment and services.

The SCA should apply the information gathered, compiled, and analyzed through the Needs Assessment process to the development of the SCA Plan for the Delivery of Treatment & Services (SCA Plan). The SCA Plan is designed to assist SCAs in defining needs and developing the resources necessary to meet those needs.

The SCA Plan must:

A. Describe trends and issues that were identified through the needs assessment process and how they will be addressed;

B. Address outcomes separately with a plan of action to meet each objective;

C. Describe the steps used for developing the plan, including the process for stakeholder input;

D. Describe the fiscal impact of each plan of action and how the SCA will allocate funding to meet the need;

E. Describe the SCA's quality management initiatives; and

F. Describe the manner through which individuals access services.

The SCA Needs Assessment and Plan must be completed and submitted according to the DDAP Report Schedule, and in accordance with the directions and any accompanying documents provided by DDAP.

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Part III - Special Populations

PART III: SPECIAL POPULATIONS

3.00 Priority Populations

A. The SCA and its contracted providers who serve an injection substance use population and who receive SABG funds shall give preference to treatment as follows in the order outlined below.

1) Pregnant women who inject drugs

2) Pregnant women who use substances

3) Persons who inject drugs

4) Overdose survivors

5) Veterans

B. All individuals in these priority populations must have a level of care assessment (LOCA) and be offered admission into the recommended level of care. If the SCA or contracted provider cannot ensure admission to the recommended level of care immediately, the individual must be offered case management services as well as admission to another level of care. Any individuals in need of emergency care should be treated as outlined in Section 5.00.

C. An SCA may not restrict access to admissions to treatment for priority populations even if it applies restriction to others.

3.01 Pregnant Women

Both the SABG and CMCSM identify pregnant women who inject drugs and pregnant women who use substances as priority populations. The SCA and its contracted providers must adhere to the following steps:

A. Screen the woman for emergent care needs.

1) If emergent care needs are identified, make an immediate referral to the appropriate service.

B. If no emergent care needs are identified and a LOCA is necessary, then conduct a LOCA to determine the need for treatment.

C. If treatment is indicated, refer the woman to a treatment provider that has the capacity to provide treatment services to the woman immediately.

DDAP has provisions for narcotic treatment programs (NTP) that are at capacity but need to admit a pregnant woman for treatment of an opioid use disorder (OUD). DDAP's Division of Program Licensure will review exception requests to increase capacity for any NTP on a case-by-case basis. In the event this is necessary, contact DDAP's Division of Program Licensure at 717-783-8200.

1) If no treatment facility has the capacity to admit the woman immediately, then;

(a) Make support services such as case management or recovery support services available within 48 hours after the LOCA, and

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Part III - Special Populations

(b) Make interim services available to the woman within 48 hours after the LOCA.

2) Interim Services are defined as services that are provided until an individual is admitted to a substance use treatment program. The purpose of interim services is to reduce adverse health effects of substance use, promote the health of the woman, and reduce the risk of transmission of a disease until the woman is admitted to a treatment program. Interim services for pregnant women must include:

(a) Counseling and education about Human Immunodeficiency Virus (HIV) and tuberculosis (TB);

(b) Counseling and education about the risks of needle sharing;

(c) Counseling and education about the risks of transmission to sexual partners and infants;

(d) Counseling and education about the steps that can be taken to ensure that HIV and TB transmission do not occur;

(e) Referral for HIV and TB treatment services, if necessary;

(f) Counseling on the effects of alcohol and drug use on the fetus; and

(g) Referral for prenatal care.

3) The SCA must maintain a resource list that clearly identifies, by physical address, phone number, and if applicable, website link, providers for each interim service. The title of each type of interim service must appear on the resource list exactly as written in the above list.

4) The SCA must have written procedures that include the mechanism to maintain contact with the pregnant woman until admission into treatment occurs. Tracking of the pregnant woman must occur by the SCA or its contracted provider regardless of whether the woman is receiving interim services.

D. The SCA must publicize the availability of preferential treatment services to pregnant women. The SCA may use street outreach programs, ongoing public service announcements on radio or television, regular advertisements in local or regional print media, posters placed in targeted areas, and frequent notification to the local network of community-based organizations, health care providers, and social service agencies.

Under the Taxpayer-Funded Transparency Act, Act 2015-90, all DDAP-funded media advertisements, except media that is funded through the Compulsive and Problem Gambling Treatment Fund, must include the statement "Paid for with Pennsylvania taxpayer dollars." Print ads must visibly display these words and broadcast advertisements must clearly have the statement read aloud during the ad. If the advertisement is broadcast or published free of charge, it does not need to include the statement.

Act 2015-90 applies to broadcast advertising such as television, radio, and other audiovisual advertising, as well as print advertising such as print and electronic newspaper and magazine advertising and billboards.Paid advertisements are defined as:

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Part III - Special Populations

Paid advertising includes media in formats such as newspaper ads, paid digital media, radio ads, TV ads, billboards, shopping cart ads, etc. in which a third party is being paid to disseminate, broadcast, publish, or post the media. Paid advertisements do not include media in formats such as brochures, newsletters, flyers, posters, magnets, stickers, etc. where funds may be spent on printing/creation of the material/item, but not to disseminate, broadcast, publish or post the media.

3.02 Persons Who Inject Drugs (PWID)

The SCA must address the needs of PWID as follows:

A. Screen all PWID for emergent care needs.

1) If emergent care needs are identified, make an immediate referral to the appropriate service.

B. If no emergent care needs are identified and a LOCA is necessary, conduct a LOCA to determine the need for treatment.

C. If treatment is indicated, refer all PWID to a treatment provider that has the capacity to provide treatment services immediately.

1) If no treatment facility has the capacity to admit the individual, then;

(a) Make support services such as case management or recovery support services available within 48 hours after the LOCA, and

(b) Make interim services available to all PWID within 48 hours after the LOCA and arrange for admission to treatment no later than 120 days after assessment. During this waiting period for admission, a mechanism for maintaining contact with the individual must be in place.

2) The definition for "Interim Services" is outlined in Section 3.01 of the CMCSM. At a minimum, interim services for PWID must include:

(a) Counseling and education about HIV and TB;

(b) Counseling and education about the risks of needle sharing;

(c) Counseling and education about the risks of transmission to sexual partners and infants;

(d) Counseling and education about the steps that can be taken to ensure that HIV and TB transmission do not occur; and

(e) Referral for HIV and TB treatment service, if necessary.

3) The SCA must maintain a resource list that clearly identifies, by address, phone number, and if applicable, website, providers for each interim service. The title of each type of interim service must appear on the resource list exactly as written in the above list.

4) The SCA must have written procedures that include the mechanism to maintain contact with the individual until admission into treatment occurs. Tracking of the

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Part III - Special Populations

individual must occur by the SCA or its contracted provider regardless of whether the individual is receiving interim services.

D. Ensure outreach activities are carried out for PWID who have not yet entered treatment. These outreach activities must be identified as Activity 7200 ? Intervention for contracting and expenditure reporting. All activities are further defined in DDAP's Fiscal Manual.

1) The SCA must have written outreach procedures that identify the following:

(a) The specific staff responsible to oversee outreach activities and the oversight process.

(b) The SCA staff or contracted provider responsible to perform outreach;

(c) The training provided to outreach workers;

(d) The specific outreach activities;

(e) The process to contact and follow up with PWID;

(f) The process to inform PWID of the relationship between injection drug use and communicable diseases like HIV;

(g) The process to inform PWID of methods to prevent the transmission of such diseases; and

(h) The process to encourage entry into treatment.

E. Require contracted providers who treat PWID to notify the SCA within seven days upon reaching 90 percent of its capacity to admit individuals to the program.

1) The SCA must have a policy and procedure in place that includes:

(a) The process for treatment providers to notify the SCA;

(b) The individual responsible for notifying the SCA;

(c) A method for the SCA to track the information received from the provider; and

(d) The process for the SCA to inform other contracted providers.

3.03 Women with Children

A. The SCA shall ensure that contracted providers who deliver services to pregnant women, women with dependent children, and women who are seeking custody of their children treat the family as a unit, when appropriate, and provide or arrange for the provision of the following services:

1) Primary medical care for women, including a referral for prenatal care, as well as childcare while the women are receiving medical care;

2) Primary pediatric care, including immunization, for their children;

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